A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Ginger Root for Migraines

Ginger Root for Migraines.jpeg

Many successful herbal treatments start like this: Some doctor learns that some plant has been used in some ancient medical tradition, like ginger for headaches. Well, the physician has patients with headaches and so tries advising one with migraines to give it a try since it's just some safe, common spice. At the first sign of a migraine coming on, the patient mixed a quarter teaspoon of powdered ginger in some water, drank it down, and poof! Within a half-hour, the migraine went away. It worked every time for them with no side effects. That's what's called a case report.

In my video, Ginger for Migraines, I show the remarkable case report, but case reports are really just glorified anecdotes. Case reports have played an important role in the history of medicine, though. AIDS was first discovered as a series of case reports. Some young guy walks into a clinic in Los Angeles with a bad case of thrush, and the rest is history. Reports of an unusual side effect of a failed chest pain drug led to the billion-dollar blockbuster, Viagra. Case reports may represent the weakest level of evidence, but they are often the first line of evidence, where everything starts. The ginger and migraine report isn't helpful in itself, but it can inspire researchers to put the treatment to the test.

The problem is, who's going to fund it? The market for migraine drugs is worth billions of dollars. A quarter teaspoon of powdered ginger costs about a penny. Who would fund a study pitting ginger versus the leading migraine drug?

No one... that is, until now. A double-blinded, randomized, controlled, clinical trial compared the efficacy of ginger to sumatriptan, also known as Imitrex, one of the top-selling billion-dollar drugs in the world in the treatment of migraine headaches. Researchers tried using only one-eighth of a teaspoon of powdered ginger versus a good dose of the drug.

They both worked just as well and just as fast.

Most patients started out in moderate or severe pain but, after taking the ginger or the drug, ended up in mild pain or completely pain-free. The same proportion of migraine sufferers reported satisfaction with the results either way. As far as I'm concerned, ginger won--not only because it's a few billion dollars cheaper than the drug, but because there were significantly fewer side effects in the ginger group. People taking sumatriptan reported dizziness, a sedative effect, vertigo, and heartburn. The only thing reported for ginger was an upset tummy in about 1 out of 25 people. (As a note of caution, taking a whole tablespoon of ginger powder at one time on an empty stomach could irritate anyone's stomach.)

An eighth of a teaspoon of ginger is not only up to 3000-times cheaper than the drug, but you're also less likely to end up as a case report yourself of someone who had a heart attack or died after taking the drug--tragedies that have occurred due to sumatriptan.

These are my favorite kinds of posts to do because I can offer something that is immediately practical, cheap, safe, and effective to reduce suffering. If this kind of information helps you or someone you love, I hope you'll consider making a tax-deductible donation to support the nonprofit organization that runs NutritionFacts.org. We have a growing staff and server costs to cover, and any help you could give would be much appreciated (and there are perks!).

For more on ginger root:

Avoiding aspartame (Aspartame and the Brain) and using lavender may also help (Lavender for Migraine Headaches). If you have cluster headaches, ask your physician about capsaicin (Hot Sauce in the Nose for Cluster Headaches?).

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

Ginger Root for Migraines

Ginger Root for Migraines.jpeg

Many successful herbal treatments start like this: Some doctor learns that some plant has been used in some ancient medical tradition, like ginger for headaches. Well, the physician has patients with headaches and so tries advising one with migraines to give it a try since it's just some safe, common spice. At the first sign of a migraine coming on, the patient mixed a quarter teaspoon of powdered ginger in some water, drank it down, and poof! Within a half-hour, the migraine went away. It worked every time for them with no side effects. That's what's called a case report.

In my video, Ginger for Migraines, I show the remarkable case report, but case reports are really just glorified anecdotes. Case reports have played an important role in the history of medicine, though. AIDS was first discovered as a series of case reports. Some young guy walks into a clinic in Los Angeles with a bad case of thrush, and the rest is history. Reports of an unusual side effect of a failed chest pain drug led to the billion-dollar blockbuster, Viagra. Case reports may represent the weakest level of evidence, but they are often the first line of evidence, where everything starts. The ginger and migraine report isn't helpful in itself, but it can inspire researchers to put the treatment to the test.

The problem is, who's going to fund it? The market for migraine drugs is worth billions of dollars. A quarter teaspoon of powdered ginger costs about a penny. Who would fund a study pitting ginger versus the leading migraine drug?

No one... that is, until now. A double-blinded, randomized, controlled, clinical trial compared the efficacy of ginger to sumatriptan, also known as Imitrex, one of the top-selling billion-dollar drugs in the world in the treatment of migraine headaches. Researchers tried using only one-eighth of a teaspoon of powdered ginger versus a good dose of the drug.

They both worked just as well and just as fast.

Most patients started out in moderate or severe pain but, after taking the ginger or the drug, ended up in mild pain or completely pain-free. The same proportion of migraine sufferers reported satisfaction with the results either way. As far as I'm concerned, ginger won--not only because it's a few billion dollars cheaper than the drug, but because there were significantly fewer side effects in the ginger group. People taking sumatriptan reported dizziness, a sedative effect, vertigo, and heartburn. The only thing reported for ginger was an upset tummy in about 1 out of 25 people. (As a note of caution, taking a whole tablespoon of ginger powder at one time on an empty stomach could irritate anyone's stomach.)

An eighth of a teaspoon of ginger is not only up to 3000-times cheaper than the drug, but you're also less likely to end up as a case report yourself of someone who had a heart attack or died after taking the drug--tragedies that have occurred due to sumatriptan.

These are my favorite kinds of posts to do because I can offer something that is immediately practical, cheap, safe, and effective to reduce suffering. If this kind of information helps you or someone you love, I hope you'll consider making a tax-deductible donation to support the nonprofit organization that runs NutritionFacts.org. We have a growing staff and server costs to cover, and any help you could give would be much appreciated (and there are perks!).

For more on ginger root:

Avoiding aspartame (Aspartame and the Brain) and using lavender may also help (Lavender for Migraine Headaches). If you have cluster headaches, ask your physician about capsaicin (Hot Sauce in the Nose for Cluster Headaches?).

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Water Should We Drink Every Day?

How Much Water Should We Drink Every Day?.jpeg

More than 2000 years ago Hippocrates (460-377 BCE) said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted "drink at least eight glasses of water a day" dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who's going to pay for them? We're left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they're sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water--like 8 cups a day--may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.

I've previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That's the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It's so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

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How Much Water Should We Drink Every Day?

How Much Water Should We Drink Every Day?.jpeg

More than 2000 years ago Hippocrates (460-377 BCE) said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted "drink at least eight glasses of water a day" dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who's going to pay for them? We're left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they're sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water--like 8 cups a day--may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.

I've previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That's the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It's so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link